﻿<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
    <title></title>
    <style type="text/css">
        .style1
        {
            text-align: left;
        }
        #Select1
        {
            width: 128px;
        }
    </style>
</head>
<body>

    <p>
        Applicant Details</p>
    <p>
        <table style="width:100%;">
            <tr>
                <td class="style1" width="20%">
                    Name</td>
                <td class="style1" width="20%">
                    <input id="Text1" type="text" /></td>
                <td class="style1" width="20%">
                    Gender</td>
                <td class="style1" width="20%">
                    <input id="Text2" type="text" /></td>
            </tr>
            <tr>
                <td class="style1" width="20%">
                    ID</td>
                <td class="style1" width="20%">
                    <input id="Text3" type="text" /></td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
            </tr>
            <tr>
                <td class="style1" width="20%">
                    Address:</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    Email</td>
                <td class="style1" width="20%">
                    <input id="Text4" type="text" /></td>
            </tr>
            <tr>
                <td class="style1" width="20%">
                    Line #1</td>
                <td class="style1" width="20%">
                    <input id="Text5" type="text" /></td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
            </tr>
            <tr>
                <td class="style1" width="20%">
                    Line #2</td>
                <td class="style1" width="20%">
                    <input id="Text6" type="text" /></td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
            </tr>
            <tr>
                <td class="style1" width="20%">
                    Line #3</td>
                <td class="style1" width="20%">
                    <input id="Text7" type="text" /></td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
            </tr>
            <tr>
                <td class="style1" width="20%">
                    State/City</td>
                <td class="style1" width="20%">
                    <input id="Text8" type="text" /></td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
            </tr>
            <tr>
                <td class="style1" width="20%">
                    Postal Code</td>
                <td class="style1" width="20%">
                    <input id="Text9" type="text" /></td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
            </tr>
            <tr>
                <td class="style1" width="20%">
                    Country</td>
                <td class="style1" width="20%">
                    <select id="Select1" name="D1">
                        <option></option>
                    </select></td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
            </tr>
            <tr>
                <td class="style1" width="20%">
                    Phone:</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
            </tr>
            <tr>
                <td class="style1" width="20%">
                    Office</td>
                <td class="style1" width="20%">
                    <input id="Text11" type="text" /></td>
                <td class="style1" width="20%">
                    Mobile</td>
                <td class="style1" width="20%">
                    <input id="Text10" type="text" /></td>
            </tr>
            <tr>
                <td class="style1" width="20%">
                    Home</td>
                <td class="style1" width="20%">
                    <input id="Text12" type="text" /></td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
            </tr>
            <tr>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
            </tr>
            <tr>
                <td class="style1" width="20%">
                    Total Income</td>
                <td class="style1" width="20%">
                    <input id="Text13" type="text" /></td>
                <td class="style1" width="20%">
                    Other Obligations</td>
                <td class="style1" width="20%">
                    <input id="Text14" type="text" /></td>
            </tr>
            <tr>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
            </tr>
            <tr>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    &nbsp;</td>
                <td class="style1" width="20%">
                    <input id="Submit1" type="submit" value="Next" /></td>
            </tr>
        </table>
    </p>

</body>
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